Variants and atypical appearances

Not every cherry angioma looks like a textbook example. Several common variants can cause momentary uncertainty, so it helps to know what to expect.

Thrombosed angioma

When blood within a cherry angioma clots — often after minor trauma — the lesion can darken dramatically. A bright red angioma may become deep purple, blue-black, or even entirely black. This is called a thrombosed angioma.

This variant matters because a dark nodule can raise concern for melanoma. The key to recognising a thrombosed angioma is to look past the colour change and find the lacunar architecture underneath. Even when the lacunae are filled with dark clotted blood rather than bright red, their round, well-defined compartmental structure is usually still visible.

Early or small angioma

Very small cherry angiomas — just a millimetre or two across — may show only a homogeneous red dot without visible lacunae or septa. These can be difficult to characterise because there is not enough internal structure to read.

In practice, a tiny, well-defined, uniformly red spot on the trunk of an adult is almost always a cherry angioma. If you are uncertain, monitoring is reasonable — as the lesion grows, lacunae typically become visible.

Targetoid angioma

Occasionally, a cherry angioma develops a pale ring or halo around it after minor trauma, creating a target-like appearance. This is sometimes called a targetoid haemosiderotic haemangioma. The halo represents blood that has leaked into the surrounding tissue and broken down, leaving haemosiderin pigment.

The central lacunar pattern is typically preserved. The surrounding halo is not concerning — it is simply evidence of previous minor bleeding.